Hospice Africa Uganda commenced in September 1993, to follow the vision of HA: “Palliative care for all in need in Africa”. With a few months funding, HAU started with a two person team confident the vision could happen with dedicated support and carers; this dedicated team was led by Dr Professor Anne Merriman. At 57 she was driven to start a project to address the overwhelming unmet need for palliative care in Africa. Having chosen Uganda for the model, with an ethos with the patient and family at the centre of all we do, an affordable culturally appropriate model for Africa was developed. This has taken time and dedication, but through 23 years, it has happened.
The vision of HA, and objectives of HAU, remain the same and the Mission of each section is to promote the vision through their different skills:
- To provide a palliative care service to patients and families in Uganda. Clinical Department and Morphine Production Unit
- To carry out education programmes so that palliative care can be available to all in need in Uganda and in Africa. Institute of Hospice and Palliative Care in Africa
- To encourage palliative care for other African countries. International Programmes Department
Access to efficient pain control, oral morphine
In this time HAU has led an effort to expand access to liquid oral morphine, and working with the Government with a change in legislation to increase prescribing to specially trained nurses and clinical officers. Uganda and many other countries in Africa have few doctors, so the Ugandan Government took up the challenge in 2003, by making morphine free to all in need who are prescribed by a registered prescriber. The law allowing midwives to prescribe pethidine for women in labour was expanded to allow nurses specially trained in palliative care to prescribe morphine. These steps have secured the ability of trained health care professionals to manage pain, the first step in providing palliative care.
Services to the patients and families
The implementation of a home based care model of palliative care is supplemented with hospital consultations where patients are allowed home as soon as possible according to their health needs and their own wishes. We also have outpatients at each HAU centre. These complementary services have been used to design a model that allows patients flexibility and options when facing the end of life.
Dr Merriman understood the importance of education to achieve the vision, and started HAU with an education department. Undergraduate teaching for nurses and doctors also commenced in 1994 along with clinical training of health care providers. Also courses were commenced for allied health professionals, volunteers, policy makers, allied professionals, traditional healers and spiritual advisors.
This department grew into the Institute of Hospice and Palliative Care in Africa (IHPCA), an independent institute of higher learning offering diploma and degree programs. Although independent in academic affairs, and reporting to the national Council of Higher Education in Uganda, the institute and the clinical service are continuously joined at the hip in order to promote the impeccable service within the pillars of our ethos. Those working within the HAU Complex are working together for the vision to be attained.
57% of Ugandans still do not reach a health worker. This percentage varies from country to country but it is estimated that 50% of all living in Africa do not reach a health professional. With desperately poor health worker to patient ratio Uganda struggles with not only the inability of patients to access services but to even know that services are available. HAU has since the beginning understood the need to inform and educate policy makers, health care professionals and communities about palliative care in general. The establishing of the Palliative Care Association of Uganda and the Association of Palliative Care in Africa were spearheaded by HAU to ensure awareness and access grows. Through tireless work of all in the palliative care community in Uganda 90 of 112 districts now have a palliative care provider. This is a start, there are still significant gaps in access that every year are shrinking.
Though about 10% of the patients in need are accessing palliative care in Uganda the World Health Organisation and the World Palliative Care Alliance have recognized Uganda as among the countries having the highest palliative care level in the world.
Hospice Africa Uganda is recognised in Uganda as a centre of excellence and a model in community based care.
The Institute of Hospice and Palliative Care in Africa is a leading institution in palliative care education in all Anglophone Africa. And the International Programmes have worked with 30 African countries to initiate palliative care.
“Levels of palliative care integration – world”. Global Atlas of Palliative Care at the End of Life WHO, WPCA, January 2014, p.39